System and Function Study of Limb Compression after Total Knee Replacement / 医用生物力学

Objective A three-dimensional （3D） printing precise pressure device was designed specifically targeted at cambered limbs according to the requirement of postoperative rehabilitation of total knee replacement(TKR), and its effectiveness and safety was verified by finite element analysis. Methods Based on gastrocnemius muscle of lower limbs as the pressurized objects, the precise pressure device was designed, which contained an air pressure generating module, an inflatable airbag and a 3D printing brace. Through the closed loop control algorithm, the device stably supplied different pressures in the airbag. Distributed pressure data of the airbag-skin within contact surface were collected under different experimental conditions and imported into biomechanical simulation software which combined CT images to reconstruct 3D model of the lower limb mechanics. Finally, the effective compression area fraction and the joint micro-motion angle under each condition were obtained, to verify the effectiveness and safety of the system. Results Using generally preferred 4 cm-size offset and 4-barrel airbag configurations, under different intracapsular pressure of 5.32，6.65，7.98，9.31，10.64 kPa, the simulated knee joint micro-motion angles were 5.3°, 6.1°, 7.2°, 9.5°, 10.6°， respectively, and the effective compression area fraction could be up to 90-8%-95-2%. Conclusions For the optimized scheme, the dynamic range of joint micro-motion angle and the effective compression area fraction caused by different airbag pressure values were the best and met the design requirements of effectiveness and safety. The research findings can contribute to analyzing the influence of compression system on limb biomechanics, which are of great significance for effective and safe rehabilitation training after TKR.

Post-operative Epidural Analgesia after TKR: A Double Blind Randomized Comparison of Ropivacaine 0.2% and Levobupivacaine 0.125%

Introduction: With the increase in the life span of humanbeings and added to that the culture of processed food thereare increase in life style disorders in humans. The commonestorthopedic problem which we see due sedentary life style,lack of healthy wholesome diet are bone related disordersmainly osteoarthritis.Ropivacaine, an alternative to bupivacaine is structurallyclosely related to bupivacaine and supplied as the pureS-enantiomer. We therefore decided to compare the efficacy ofcontinuous infusion of levo bupivacaine against ropivacaine toidentify the differences or superiority of one drug over other.Material and methods: After obtaining the Ethics Committeeapproval, we recruited 110 patients undergoing Total KneeReplacement (TKR) surgery under Combined Spinal Epidural(CSE) Anaesthesia. Sample size of study which was calculatedas 110. All patients underwent a routine pre anaesthetic checkup including the spine examination. Pre-anaesthetic check- upwas done a day prior to surgery. All routine investigationswere advised. The details of our study were explained to thepatients, in the language understood by them. Consent wasobtained for post-operative use of Elastomeric infusion pump.They were explained about the use of VAS.Results: Both groups were comparable with respect todemographic profile. The patients in ropivacaine group showedsignificantly lower pulse rate as compared to levobupivacainegroup. Patients in ropivacaine group recorded significantlylower systolic blood pressure throughout the infusion periodas compared to those in the levobupivacaine group. Thedifference in diastolic blood pressure was not significant. Thetime taken for the sensory block to regress to L1 was longerin ropivacaine group as compared to levobupivacaine group.Conclusion: Patients in both the group had comparable VASpost operatively. Although Patients in the ropivacaine grouphad better VAS score as compared to levobupivacaine, thedifference was not statistically significant. There were noside effects like motor weakness, hypotension, bradycardia orPNOV in any group. Our present study thus concludes thatas far as analgesic properties are concerned Ropivacaine withits more suitable toxicity profile and less motor block is morefavourable for continuous infusion for patients undergoingTKR when used in equipotent doses.

Establishment and Verification of Personalized Musculoskeletal Model Based on nmsBuilder and OpenSim / 医用生物力学

Objective To establish a personalized musculoskeletal multi-body dynamics model of total knee replacement (TKR) by two software nmsBuilder and OpenSim, and verify this established model by using bouncy and medthrust gait patterns. Methods Based on skeletal data from a patient, the body, skeletal landmark clouds and muscular landmark clouds were established for automatically generating reference systems and muscles. The musculoskeletal model generated by nmsBuilder was introduced into OpenSim, and inverse kinematics, static optimization and knee joint force analysis were performed successively. Finally, the model was driven by bouncy gait and medthrust gait respectively, and the results were compared with experimental measurements. Results Except for the lateral joint contact forces, the predicted magnitude and trend of knee joint contact forces by the model had a good agreement with the experimental data, and the constructed skeletal muscle multi-body dynamics model could be used for knee joint research. Conclusions The established musculoskeletal multi-body dynamics model could predict the medial, lateral and total tibiofemoral joint contact forces simultaneously by inputting the marker positions and the ground reaction forces. The research ideas of this study can provide references for designing personalized knee prostheses for TKR patient.

Effectiveness of balance training to improve function in patients in post-operative phase following total knee arthroplasty

Background: Knee osteoarthritis is the occurrence of osteoarthritis (OA) in the knee joint. Osteoarthritis involves the degradation of joints, including articular cartilage and subchondral bone. Osteoarthritis is the most common disease of joints adults suffer from worldwide. The most common procedures done for the treatment of osteoarthritis of knee is a surgical procedure called Total knee arthroplasty (TKA) or total knee replacement (TKR) which is mostly done in advance cases. It is usually starts from age group of 40 and slowly progresses. The most common age group in which its seen is between 50-60 years. They slowly start losing balance after the TKR. Balance is an important aspect of mobility and physical function. Patients with severe OA who are awaiting total hip arthroplasty (THA) or total knee arthroplasty (TKA) are reported to have a higher incidence of falls compared to the general population. Balance Training Exercises with Conventional Therapy gives much better effect. So, the aim of the study is to check the effectiveness of balance training to improve function in patients in post-operative phase following total knee arthroplasty. Materials and methods: 60 patients were included in the study which was divided into two groups; Group A and Group B, 30 patients in each group. Subjects were randomly selected and assigned to each group. Pre-test measurements of the patient were done with the help of TUG for each group. The Sreenivasu Kotagiri, Neeti Mathur, Swapna, I Venkateshwarlu, Anup Kumar Songa. Effectiveness of balance training to improve function in patients in post-operative phase following total knee arthroplasty. IAIM, 2019; 6(10): 56-63. Page 57 Subjects in Group-A were given Conventional Therapy. The Subjects in Group-B were given Balance Training Exercises with Conventional Therapy. Then the Result analysis was done. Results: On comparing Group A and Group B for post-treatment TUG score, results showed a significant difference (p=0.001). The overall study proved that Balance Training Exercises with Conventional Therapy is beneficial in improving functional activities and decreasing the disability level. Conclusion: The analysis obtained indicated that Group B (Balance Training Exercises with Conventional Therapy) showed more significant improvement when compared to Group A (Conventional therapy).

Finite element study on total knee prosthesis wear during stair ascent / 医用生物力学

Objective To study the effect of stair ascent on insert wear of total knee replacement (TKA) by finite element model, which is of great theoretical and practical significance for improvement of wear evaluation method and guidance of design of artificial knee joint prosthesis. Method A finite element analysis model of TKR wear based on Archard’s law was established and validated. The model was applied with loads under normal level walking (ISO14243) and stair ascent, respectively, to compare and analyze the influence of stair ascent on TKR wear. Results The predicted wear during level walking was consistent with experimental results reported in the literature. The volumetric wear rate during stair ascent was 37.10 mm3 per million cycles (MC), which was significantly higher than that during level walking (16.94 mm3/MC). The linear wear during stair ascent was significantly higher than that during level walking as well. Wear during stair ascent was mainly distributed in the backward area of medial platform, which was obviously different from that during level walking. Conclusions As a common daily activity with high loads and high flexion angles, stair ascent contributes an important part in TKR wear, and more attention should be paid to the testing and evaluation of TKR wear.

Musculoskeletal multi-body dynamic simulation on patient-specific total knee replacement during right-turn gait / 医用生物力学

Objective To develop a musculoskeletal multi-body dynamic model of the patient-specific total knee replacement (TKR), and to simulate knee joint biomechanical characters of the patient during right-turn gait. Methods Based on the musculoskeletal dynamic software AnyBody and the method of force-dependent kinematics as well as the related data from a patient with TKR, the corresponding patient specific lower extremity musculoskeletal multi-body dynamic model was constructed and then used to simulate the right-turn gait of the patient. The knee contact forces, motion, muscle activations and ligament forces were predicted simultaneously by inverse dynamics analysis on such right-turn gait. ResultsThe root mean square error of the predicted average tibiofemoral medial contact force and lateral contact force were 285 N and 164 N, respectively, and the correlation coefficients were 0.95 and 0.61, respectively. The predicted average patellar contact force was 250 N. The predicted contact forces and muscle activations were consistent with those in vivo measurements obtained from the patient. In addition, the model also predicted the average range of tibiofemoral rotations of flexion-extension, internal-external, varus-valgus as 3°-47°, -3.4°-1.5°, 0.2°--1.5°, and the average range of tibiofemoral translations of anterior-posterior, inferior-superior, medial-lateral as 2.6-9 mm, 1.6-3.2 mm, 4.2-5.2 mm, respectively. The predicted average peak value of the medial, lateral collateral ligament force and posterior cruciate ligament force were 190, 108, 108 N, respectively. Conclusions The developed model can predict in vivo knee joint biomechanics, which offers a robust computational platform for future study on the failure mechanisms of knee prosthesis in clinic.

The Effectiveness of Music Therapy for Post-Operative Pain Control among Total Knee Replacement Patients

Pain is an unpleasant sensation that can cause physical and psychological problems for the patient. Despite the pharmacological intervention for reducing pain, it remains as an issue after surgery. Music therapy as non-pharmacological intervention can effect post-operative pain and patients’ requirement of analgesics. The purpose of this study was to determine effect of music therapy on pain after elective total knee replacement (TKR) surgery. This study compared analgesics consumption by patients post-operatively for five days. A Quasi-experimental design with convenience sample of patient with a mean of 64.35 (49-76) who underwent TKR in UKM Medical Centre from May to December 2012 was used. Forty patients were randomly assigned in one of the two groups using a sealed-envelope technique. The experimental group listened to music for five days post-operatively and were on analgesics and control group were treated with pharmacological intervention only. Pain was measured by McGill Pain Questionnaire-Short Form (MPQ-SF) for patient on bed rest on day one, day three and day five post-operatively. Statistical (Mann- Whitney) findings between groups showed the experimental group significantly had less pain on day one and day five rather than the control group at 0.05 level using Pain Rating Intensity (PRI), Visual Analogue Scale (VAS) and Present Pain Intensity (PPI). Statistical (Friedman) tests within group showed that the patient had significantly decreased pain over time at level 0.05 using PRI, VAS and PPI. Statistical (Mann- Whitney) tests revealed that there was no significant difference when using analgesics between the two groups in five days post-operatively at milligram but comparing median showed experimental group used less analgesic than control group. Music therapy is simple, available, save and cheap effective intervention for pain management post-operatively. Pain management is one of the key roles of nursing and nurses can use music therapy as a simple intervention to reduce pain.

Two-Stage Reimplantation for the Treatment of Infected Total Knee Arthroplasty / 대한정형외과학회잡지

Deep infection following arthroplasty of the knee is a serious complication resulting in pain, discharge and loss of function. The incidence of deep infection ranges from 1% to 2% in a majority of reported series. There are several options for treatment of infected total knee arthroplasty: (1) antibiotic suppression, (2) debridement, (3) resection arthroplasty, (4) reimplantation, (5) arthrodesis, (6) amputation. Among them, recent reports have favored a two-staged regimen exchanging the prosthesis in an infected knee by using an antibiotic impregnated cement spacer. The result of our study support this option for treatment. We have experienced 14 cases of two-staged reimplantation in infected total knee arthroplasty, diagnosed according to the criteria described by Bengstons and followed up for more than two years. The average interval from prosthesis removal to revision was 6.85 weeks. Prior to revision, the average knee score was 50 points, and the average range of motion was 74 degree. After revision, the average knee score was 81 points. The average range of motion was 95 degree. Our protocol for the treatment successfully eradicated the deep infection in 13 patients, only a patients who had severe rheumatoid arthritis was the sole documented case of reinfection.

Quality of Life after Total Knee and Total Hip Replacement

We reviewed 40 consecutive patients having a primary total hip replacement(THR) and 60 patients having a primary total knee replacement(TKR) for osteoarthritis to compare the qu;dity of hfe(QoL) before and after operation. Bilateral arthroplasties were perfomed 10 cases of THR and 25 cemes of TKR. We used a modified Harris hip score and a knee score of American knee society, the Rosser Lndex Matrix and authors eval- uation system to generate these scores. Quality of life was highly improved by Rossers and authors evalua- tion system after THR and TKR. The median values of QoL scores before and after operation were signifi- cantly different(petter than in TKR. Postoperative QoL scores for both groups were similar. Quality of life evaluated by Rossers score and authors evaluation system in bilateral THR was better than bilateral TKR. We think better quality of life in bilateral THR over bilateral TKR by authors evaluation system is because the hip joint is mcire stable and has better range of motion than knee joint. We conclude that change of life style including the use of bed, toilet seat elevation, and the use of dinning table will be neccesary after bilateral TKR.

Gene expression of tyrosine kinase receptor pathway in primary glioblastoma and its significance / 中国癌症杂志

Background and purpose:Glioblastoma is one of the most common intracranial tumors, the morbidity and mortality are both high, and the molecular biological mechanism of the disease is still unclear. In this study, we detected the gene expression of tyrosine kinase receptor (TKR) pathway in primary glioblastoma(GBM) with low-density array, furthermore we analyzed the significance of the gene expression change. Methods:We detected 26 genes of RTK pathway in 10 primary GBM tissues and 9 normal brain tissues (gained from the decompression operation of brain trauma), and analyzed the different expressions of these two kinds of tissues by statistic method.Results:The Ct values of MAP2K1 and MAP2K4 in normal brain tissues were 1.6?1.7 and 2.2?2.1, the Ct values of MAP2K1 and MAP2K4 in primary GBM tissues were 3.9?1.5 and 5.0?2.0, and the Ct different values between normal brain tissues and primary GBM tissues of both genes were -2.3 and -2.8(P

TKR in Fused Knee / 대한정형외과학회잡지

There are many difficulties in operative technique of total knee replacement of bony ankylotic knee, because it accompanies the deformity of the knee, contracture of soft tissue and bony ankylosis. It is said that there are poor gaining of post-operative range of motion and development of many problems in wound healing. We performed conversion TKR in seventeen patients who had fused knee between Jan. 1985 and Dec. 1991. After follow up of average three years and four months, we analyse the results. Sixteen patients were women and one was man. There were eight cases of tuberculosis knees, seven cases of septic knees and two cases of posttraumatic arthritis. Thirteen cases had previous knee surgery and in another four cases knee fusion developed spontaneously. Average age of patients were 35 years old. Operation was performed between ten months and twenty years averaging nine years after knee fusion. When blood chemistry and physical examination showed no findings of infection, operation was performed. We used bone cement in 8 cases and autogenous bone graft in 4 cases for large bone defect. For release of soft tissue contracture, in 8 cases, we lengthened quadriceps tendon with the method of V-Y advancement technique and in another 4 cases, performed patella tendon transfer from tibial tuberosity. Operative time was between three hours and four hours fifteen minutes, average three hours and fourty minutes. The results of these patients were as follows; 1. The postoperative average range of motion was 72° (20°-125°). The average extension lag was 9. 2. The average Hospital for Special Surgery knee rating score improved from 57 preoperatively to 84 postoperatively. 3. There were two patients who had pain on walking, but radiologically and clinically there were no loosening signs. 4. In three patients who had poor gaining of range of motion after operation, we performed arthroscopic adhesiolysis. There were two cases of transient peroneal nerve palsy which were recovered within 1 month and in another two case of deep infection with β-hemolytic streptococcus and pseudomonas, we performed knee fusion after one year ten months and one month after TKR. In conclusion, conversion TKR is a successful procedure which can obtain the restoration of function of the fused knee, especially in the cases that have adequate soft tissue condition, extensor mechanism and good bone stock.

Total Knee Replacement in Rheumatoid Arthritis / 대한정형외과학회잡지

The symptoms of the rheumatoid arthritis are variable enough to be ranged from mild to severe case. Synovectomy, fusion, and total knee replacement are to be applied according to the site and degree of involvement as surgical treatments. In the analysis, we compare the result of PCL retention TKR patients with those of PCL sacrificing TKR patients and of cemented TKR patients with those of cementless TKR patients. Function of the knee was evaluated using the knee score system of the Hospital for Special Surgery. From Nov, 1982 to Nov. 1990, total knee replacment was performed on 128 knees in 77 patients with rheumatoid arthritis at the Kyung Hee University Hospital and were followed for from two to ten years(average, four years eleven months). 1. The age at operation was ranged from 21 years to 72 years(average 53.2 years). There were seventy one female and six male patients. 2. The cruciate sacrificing prosthesis(group I ) were 42 cases and cruciate retention prosthesis(group II) were 86 cases. 3. The average preoperative range of motion was 85. 5 degree and the average post-operative range of motion was 107. 7 degree. Group I changed from 74. 7 degree to 105. 8 degree and Group II changed from 90. 5 degree to 108. 5 degree. 4. The average preoperative flexion contracture was 28. 7 degree and average post-operative flexion contracture was 7.8 degree. Group I changed from 37 degree to 8.4 degree and Group II changed from 24. 7 degree to 7. 5 degree. 5. The average preoperative tibiofemoral angle was varus 7. 4 degree in 69 cases and valgus 7. 6 degree in 59 cases. The average postoperative tibiofemoral angle was valgus 7. 2 degree. 6. The average preoperative knee Rating Score was 35. 2 point and the average postoperative score improved to 82. 7 point. Group I changed from 31. 3 point to 79. 4 point and Group II changed from 37 point to 84. 2 point. 7. 107 cases were cemented TKR and the 21 cases were cementless. There was no significant difference in those groups. 8. Additional operations were THR in eight cases, TER in five cases, TAR in four cases, TSR in one case, TWR in one case, Swanson prosthesis in one case, knee synovectomy in two cases, elbow synovectomy in three cases, and wrist synovectomy in two cases. 9. Complication included loosening in one case, partial ankylosis in three cases, and deep infection in one case.

Comparative Analysis of TKR in Preoperative Ambulatory and Non / 대한정형외과학회잡지

At Orthopaedic Department of Kyung Hee University Hospital, we performed 50 total knee replacement in 32 patients who had suffered from rheumatoid arthritis during the period from Aug. 1982 to Dec. 1987. We studied these cases and compared the results of total knee replacement surgery in preoperative ambulatory patients(group I ) with those in preoperative non-ambulatory patients(group II ). 1. Preoperatively, 19 patients were able to walk, and 13 patients were unable to walk. 2. 7 patients of bilateral TKR(36.8%) were included in group I, and 11 patients (86.9%) in group II. 3. The improvement of range of motion after TKR was greater in group II (34 degrees) and in group I, average postoperative range of motion was similar to the average preoperative ROM. 4. Flexion contracture was more markedly improved in group II. 5. In group I, the average preoperative knee rating score by Hospital for Special Surgery rating system was 38.8 and improved to 93.4 postoperatively. In group II, the average preoperative knee rating score was 27.4 and improved to 85.7 postoperatively. 6. Postoperatively most of the patients were able to walk without support except one cases of infection(group I ) and the other who had severe rheumatoid involvements in other joints (group II ). 7. Preoperative evaluation for involvements of cervical spine and surrounding soft tissue structure was necessary endotracheal anesthesia. 8. There was 2 cases of complications in group I, and 4 cases in group II.